Economist John Goodman explains why you typically cannot reach your doctor on the phone or over the Internet: Medicare and insurers don’t pay them for this. This changes when you pay your doctor directly. The Denver Business Journalreports on a new direct-pay medical office where doctors are available at all times:

Dialysis center giant DaVita Inc. has opened its first primary-care center in Colorado, offering concierge medicine to both employees and outsiders in what it says is an effort to improve health and reduce costs by competing with traditional physicians’ practices.

Paladina Health LLC, a clinic that opened on Sept. 3 at 1783 15th St., offers two physicians and two medical assistants to treat individuals or employers who pay a monthly fee. …

Under the concierge medicine concept practiced there, patients will pay a monthly fee — $99 for adults, $59 for children and various negotiated prices for companies — and receive unlimited services from doctors rather than paying per visit, Steinfort said.

By allowing doctors to spend more time with patients, and be available to them via cellphone and web portal at all times, DaVita believes it can drive improvements to customer service and to health while cutting the cost of care if patients don’t wait until they are severely ill to see a doctor, Steinfort said.

Tom Blue, Executive Director of the American Academy of Private Physicians, says that doctors are seeing revenue drop precipitously as the costs of regulations, drugs and medical liability skyrocket, while reimbursements from public and private insurance providers plunge.

In response, Blue says that a growing number of doctors are converting their practices to a new business model that cuts out the middle men, and enhances the doctor-patient relationship.

Direct-pay medical contracts require a one-time annual fee that buys 24/7 access to a primary care physician, same day appointments and a doctor-patient relationship reminiscent of an era before third party insurers and government subsidies.